864
CORRESPONDENCE
you don't.―I would like to recommend an article by B.G. Braun (1984). Professor Merskey seemsto overestimate the power of hypnosis. As Braun explains,MPD cannot beproducedby hypnosis,but it can beunveiled by hypnotic techniques. BRAUN, B. 0. (1984) Hypnosis creates multiple personality: myth or reality? International Journal of Clinical and Experimental
Hypnosis,32,191—197. ULLA KARILAMPI
Studiegángen 17-306 5-41681 Gothenburg
lessdepressionin the Chinese(Xu, 1987).Excessive emotional activity of any kind may causeimbalance of Yin and Yang, blockade of Qi, malfunction of organs and henceillness. More specifically, violent anger is hurtful to Yin, and violent joy is hurtful to Yang. A person with an irascible personality is described as hou-qu-ta rather than ‘¿borderline' amongMandarin-speaking Chinese(Lin eta!, 1980). Sorrow counteractsanger,lending somecredenceto the psychoanalytic theory that anger repressedand turned againstthe selfbecomesdepression. In investigating the Korean culture-bound ‘¿anger'
The neglectof angerin Westernpsychiatry
syndrome of Hwa-Byung, Lin et a! (1992) recently suggestthe addition of an ‘¿anger syndrome' in the DSM—IIIsystem.Notwithstanding the social risk of legitimising anger and aggressionas diseasestates,
SIR: I read with interest the review on anger by
and not alwaysfruitful researchefforts that Western
Kennedy (Journal, August 1992,161, 145—153), and fully support the view that the clinical assessmentof anger,its antecedents,consequences,and treatability has beenneglected.In the handbook on psychiatric examination (Institute of Psychiatry, 1987)which is piously used by psychiatric trainees, mood assess ment includes, among others, spirits, anxiety, tear fulness,and guilt, but not anger.Clinically, extreme statesof depressionor anxiety arereadily regardedas
psychiatry has elected to spend on depressive and
Sweden
a disorder which is out of a patient's own control and
requirespsychiatric treatment. In contrast, similarly severe attacks of rage are often conceived, if not
stigmatised, as being within a person's own moral responsibility, unlessthe anger is epiphenomenally
morbid anger deserves a fair share of the enormous
anxiety states. INSTITUTEOFPSYCHIATRY(1987) Psychiatric Examination: Note on
Eliciting and Recording Clinical Information in Psychiatric Patients(2ndedn).Oxford:OxfordUniversityPress. Lm, K. M., KLEINMAN,A. & UN, T. Y. (1980) Overview of mental
disorders in Chinese cultures: review of epidemiological and clinical studies. In Normal and Abnormal Behaviour in Chinese
Culture(edsA. Kleinman& T. Y. Lin), pp.237—272. Boston: D. Reidel. LAU, J. K. C., YAMAMOTO,J., ci a! (1992) Hwa-Byung—a
community study of Korean Americans.Journal of Nervousand MentalDisease,180,386—391. Wu, D. Y. H. (1982) Psychotherapyand emotion in traditional Chinese medicine. In Cultural
Concepts of Mental
Health
and Therapy(edsAJ. Marsella& G.M. White), pp.285—301.
Dordrecht:Reidel. thought to underlie manifest depression and Xu,J. M.(1987) Someissuesin thediagnosisof depressionin China. hence should be ‘¿ventilated'. Unlike sadness or CanadianJournalof Psychiatry.32,368—370. apprehension, anger easily provokes negative countertransferenceand may selectivelyberepressed SINGLi@ by the psychiatric profession. If morbid anger hasa Departmentof Psychiatry biological basis akin to depressionor anxiety and Chinese University of Hong Kong, Shatin responds equally well (or poorly!) to psychiatric Hong Kong treatment, then many affected subjects may have been unjustifiably sent to prison.
Dr Kennedy may like to add to his review the Chineseconceptsof emotionsandpathogenesis(Wu, 1982).Traditional Chinesemedicine,as recordedin the classicaltext of Huang-ti Nei-ching(the ‘¿Bible of Chinese medicine') more than 2000 years ago, stressesthe importance of a balanced life, and the regulation of the sevenemotions(qi-qing). Insteadof
The Northfield Experiments Su@:As psychoanalysts practising analytic group
psychotherapy in a mental hospital, we read with great interest Harrison & Clarke's paper about the
Northfield Experiments (Journal, May 1992, 160,
a simplistic depression-elation paradigm, the seven
698—708). It might be of interest to the readers of the
emotions include joy, anger, worry, contemplation, sorrow, apprehension,and fright which maydialecti cally interact with one another. Depressiondoesnot rank high among theseemotions,explaining to some extent the reputed lack of lexicon to expressde pression and the controversial issueof there being
Journal to know that there is a psychotherapeutic ward in a state hospital in Switzerland (Haus 14, Kantonale Psychiatrische Klinik Wil, St Gallen) which is explicitly committed to the concepts
developed at Northfield. This is the only psycho analytically orientated unit in a large clinic, and we
865
CORRESPONDENCE
approach continuously against many odds, we are
of placement but no powers of treatment. The local environmental healthdepartmentcanuseother legislation to deal with squalor (Mulroy & Shah, 1992). Section 83 of the Public Health Act 1936 (amended by Section 35 of the 1961Act) suggests that if “¿filthy or verminous premises― exist, then notice can be servedto the owners or occupiers of the property to cleanup. If this is not complied with then the environmental health departmentcan clean up. An adjunct to this is Section 84 of the Public Health Act 1936,whereupon “¿filthy and verminous
grateful to Drs Harrison & Clarke for their summary
persons― can be “¿deloused―.
encounter many of the problems described by Drs Harrison
& Clarke.
In dealing with them we find the
ideasofTom F. Main, and his emphasison the care ful consideration of the community as a whole, especially helpful. We share with Wilfried R. Bion the experience that, given the proper setting, even very disturbed patients can develop a sense of re sponsibility
to their group, to the hospital, and to
society as a whole.
As we have to defend our general analytic of the historical roots of the work we do. We certainly
Prevention of damage by the Pest Act 1949
agreethat the “¿lessons learnedat Northfield remain relevant to the practiceof psychiatry today―.
(Section 4) may be useful if there is evidence of infestation with rats and mice. This can be served upon owners and occupiers.The neighboursmay be able to invoke the nuisanceprovision under Section
HEDI HA.n@I KLAUS HOFFMANN
Instit utfur Psychoanalyse Waffenplatzstrasse36 Postfach6906 CH-8023
80 of the Environmental Protection Act 1990. CLARK,A., MANIKAR, G. & GRAY, I. (1975) Diogenes syndrome:a
clinical studyof grossneglectin old age.Lancet,i, 366—368.
Zurich
CYBULSKA, E. & RUCINSKI, J. (1986)
Switzerland
Gross
self neglect
in old age.
British Journal of Hospital Medicine, July, 21—24. MACMILLAN, D. & SHAW,P. (1966) Senile breakdown in standards
of personal and environmental cleanliness. British Medical Journal, ii, 1032—1037. MULROY, R. & SHAH,A. K. (1992) Indescribable squalor. Update, (in press).
Self-neglectin adult life SIR: I read
with
interest
the recent
case reports
on
self-neglect in adult life (Journal, August 1992, 161,
265—267). Thesetwo casesare not the only casesof squalor among younger patients. MacMillan & Shaw (1966) noted this in their original series,and this issue has been debated more recently (Shah,
ORRELL,
M.,
SAHAKIAN, B. & BERGMANN, K. (1989)
Self neglect
andfrontallobedysfunction. BritishJournalof Psychiatry, 155, 101—105. SHAH,AK. (1991) Senile squalor syndrome- a misnomer?Care of the Elderly. 3, 52.
—¿(1992)Senile squalor syndrome: a small series.Care of the Elderly,4,299-300.
1991).It hasbeensuggestedthat ageis not important MIT in the development of this syndrome (Shah, 1991). AcademicUnitfor Psychiatryof Old Age Frontal lobe dysfunction (with or without dementia) St Vincent'sHospital Clinical School has been suggested to be associated with the syn drome (Orrell et a!, 1989: Shah, 1992). It would be Mont Park Hospital Campus interesting to know if Drs Vostanis& Dean haveany Private Bag No. 1 Rosanna evidence of frontal lobe dysfunction in either patient (particularly Case 1, who had the revised Weschler Victoria 3084 Australia Adult Intelligence Scaletest). These patients can be managed through psychi atric servicesand the Mental Health Act when there is evidence of mental illness (Cybulska & Rucinski, The designationof black peoplein psychiatric 1986;Muiroy & Shah, 1992).However,up to 50% of research
SHAH
these patients do not have psychiatric disorder
(MacMillan & Shaw,1966;Clark eta!, 1975).In such situations, Section47 of the National AssistanceAct 1948could beused.Here the patient can beremoved to a place of safety (usually a hospital bed) “¿if he is suffering from grave chronic diseaseor, being aged, infirm or physically incapacitated, is living in insanitary conditions and is unable to devote to himself and is not receiving from other persons
proper care and attention―.This act offers powers
SIR: Anthropologically
speaking,
there are only three
major ethnic divisions of Homo sapiens,namely the negroid, caucasoidand mongoloid races.Although the words ‘¿negroid' and ‘¿negro' are still used in
anthropology, there has been a tendency to avoid their useelsewhere,as theseterms have,principally thanks to American racism and the resultant civil rights movements,acquired a connotation of racial abuse. (Similar considerations apply to the term
CORRESPONDENCE
you don't.―I would like to recommend an article by B.G. Braun (1984). Professor Merskey seemsto overestimate the power of hypnosis. As Braun explains,MPD cannot beproducedby hypnosis,but it can beunveiled by hypnotic techniques. BRAUN, B. 0. (1984) Hypnosis creates multiple personality: myth or reality? International Journal of Clinical and Experimental
Hypnosis,32,191—197. ULLA KARILAMPI
Studiegángen 17-306 5-41681 Gothenburg
lessdepressionin the Chinese(Xu, 1987).Excessive emotional activity of any kind may causeimbalance of Yin and Yang, blockade of Qi, malfunction of organs and henceillness. More specifically, violent anger is hurtful to Yin, and violent joy is hurtful to Yang. A person with an irascible personality is described as hou-qu-ta rather than ‘¿borderline' amongMandarin-speaking Chinese(Lin eta!, 1980). Sorrow counteractsanger,lending somecredenceto the psychoanalytic theory that anger repressedand turned againstthe selfbecomesdepression. In investigating the Korean culture-bound ‘¿anger'
The neglectof angerin Westernpsychiatry
syndrome of Hwa-Byung, Lin et a! (1992) recently suggestthe addition of an ‘¿anger syndrome' in the DSM—IIIsystem.Notwithstanding the social risk of legitimising anger and aggressionas diseasestates,
SIR: I read with interest the review on anger by
and not alwaysfruitful researchefforts that Western
Kennedy (Journal, August 1992,161, 145—153), and fully support the view that the clinical assessmentof anger,its antecedents,consequences,and treatability has beenneglected.In the handbook on psychiatric examination (Institute of Psychiatry, 1987)which is piously used by psychiatric trainees, mood assess ment includes, among others, spirits, anxiety, tear fulness,and guilt, but not anger.Clinically, extreme statesof depressionor anxiety arereadily regardedas
psychiatry has elected to spend on depressive and
Sweden
a disorder which is out of a patient's own control and
requirespsychiatric treatment. In contrast, similarly severe attacks of rage are often conceived, if not
stigmatised, as being within a person's own moral responsibility, unlessthe anger is epiphenomenally
morbid anger deserves a fair share of the enormous
anxiety states. INSTITUTEOFPSYCHIATRY(1987) Psychiatric Examination: Note on
Eliciting and Recording Clinical Information in Psychiatric Patients(2ndedn).Oxford:OxfordUniversityPress. Lm, K. M., KLEINMAN,A. & UN, T. Y. (1980) Overview of mental
disorders in Chinese cultures: review of epidemiological and clinical studies. In Normal and Abnormal Behaviour in Chinese
Culture(edsA. Kleinman& T. Y. Lin), pp.237—272. Boston: D. Reidel. LAU, J. K. C., YAMAMOTO,J., ci a! (1992) Hwa-Byung—a
community study of Korean Americans.Journal of Nervousand MentalDisease,180,386—391. Wu, D. Y. H. (1982) Psychotherapyand emotion in traditional Chinese medicine. In Cultural
Concepts of Mental
Health
and Therapy(edsAJ. Marsella& G.M. White), pp.285—301.
Dordrecht:Reidel. thought to underlie manifest depression and Xu,J. M.(1987) Someissuesin thediagnosisof depressionin China. hence should be ‘¿ventilated'. Unlike sadness or CanadianJournalof Psychiatry.32,368—370. apprehension, anger easily provokes negative countertransferenceand may selectivelyberepressed SINGLi@ by the psychiatric profession. If morbid anger hasa Departmentof Psychiatry biological basis akin to depressionor anxiety and Chinese University of Hong Kong, Shatin responds equally well (or poorly!) to psychiatric Hong Kong treatment, then many affected subjects may have been unjustifiably sent to prison.
Dr Kennedy may like to add to his review the Chineseconceptsof emotionsandpathogenesis(Wu, 1982).Traditional Chinesemedicine,as recordedin the classicaltext of Huang-ti Nei-ching(the ‘¿Bible of Chinese medicine') more than 2000 years ago, stressesthe importance of a balanced life, and the regulation of the sevenemotions(qi-qing). Insteadof
The Northfield Experiments Su@:As psychoanalysts practising analytic group
psychotherapy in a mental hospital, we read with great interest Harrison & Clarke's paper about the
Northfield Experiments (Journal, May 1992, 160,
a simplistic depression-elation paradigm, the seven
698—708). It might be of interest to the readers of the
emotions include joy, anger, worry, contemplation, sorrow, apprehension,and fright which maydialecti cally interact with one another. Depressiondoesnot rank high among theseemotions,explaining to some extent the reputed lack of lexicon to expressde pression and the controversial issueof there being
Journal to know that there is a psychotherapeutic ward in a state hospital in Switzerland (Haus 14, Kantonale Psychiatrische Klinik Wil, St Gallen) which is explicitly committed to the concepts
developed at Northfield. This is the only psycho analytically orientated unit in a large clinic, and we
865
CORRESPONDENCE
approach continuously against many odds, we are
of placement but no powers of treatment. The local environmental healthdepartmentcanuseother legislation to deal with squalor (Mulroy & Shah, 1992). Section 83 of the Public Health Act 1936 (amended by Section 35 of the 1961Act) suggests that if “¿filthy or verminous premises― exist, then notice can be servedto the owners or occupiers of the property to cleanup. If this is not complied with then the environmental health departmentcan clean up. An adjunct to this is Section 84 of the Public Health Act 1936,whereupon “¿filthy and verminous
grateful to Drs Harrison & Clarke for their summary
persons― can be “¿deloused―.
encounter many of the problems described by Drs Harrison
& Clarke.
In dealing with them we find the
ideasofTom F. Main, and his emphasison the care ful consideration of the community as a whole, especially helpful. We share with Wilfried R. Bion the experience that, given the proper setting, even very disturbed patients can develop a sense of re sponsibility
to their group, to the hospital, and to
society as a whole.
As we have to defend our general analytic of the historical roots of the work we do. We certainly
Prevention of damage by the Pest Act 1949
agreethat the “¿lessons learnedat Northfield remain relevant to the practiceof psychiatry today―.
(Section 4) may be useful if there is evidence of infestation with rats and mice. This can be served upon owners and occupiers.The neighboursmay be able to invoke the nuisanceprovision under Section
HEDI HA.n@I KLAUS HOFFMANN
Instit utfur Psychoanalyse Waffenplatzstrasse36 Postfach6906 CH-8023
80 of the Environmental Protection Act 1990. CLARK,A., MANIKAR, G. & GRAY, I. (1975) Diogenes syndrome:a
clinical studyof grossneglectin old age.Lancet,i, 366—368.
Zurich
CYBULSKA, E. & RUCINSKI, J. (1986)
Switzerland
Gross
self neglect
in old age.
British Journal of Hospital Medicine, July, 21—24. MACMILLAN, D. & SHAW,P. (1966) Senile breakdown in standards
of personal and environmental cleanliness. British Medical Journal, ii, 1032—1037. MULROY, R. & SHAH,A. K. (1992) Indescribable squalor. Update, (in press).
Self-neglectin adult life SIR: I read
with
interest
the recent
case reports
on
self-neglect in adult life (Journal, August 1992, 161,
265—267). Thesetwo casesare not the only casesof squalor among younger patients. MacMillan & Shaw (1966) noted this in their original series,and this issue has been debated more recently (Shah,
ORRELL,
M.,
SAHAKIAN, B. & BERGMANN, K. (1989)
Self neglect
andfrontallobedysfunction. BritishJournalof Psychiatry, 155, 101—105. SHAH,AK. (1991) Senile squalor syndrome- a misnomer?Care of the Elderly. 3, 52.
—¿(1992)Senile squalor syndrome: a small series.Care of the Elderly,4,299-300.
1991).It hasbeensuggestedthat ageis not important MIT in the development of this syndrome (Shah, 1991). AcademicUnitfor Psychiatryof Old Age Frontal lobe dysfunction (with or without dementia) St Vincent'sHospital Clinical School has been suggested to be associated with the syn drome (Orrell et a!, 1989: Shah, 1992). It would be Mont Park Hospital Campus interesting to know if Drs Vostanis& Dean haveany Private Bag No. 1 Rosanna evidence of frontal lobe dysfunction in either patient (particularly Case 1, who had the revised Weschler Victoria 3084 Australia Adult Intelligence Scaletest). These patients can be managed through psychi atric servicesand the Mental Health Act when there is evidence of mental illness (Cybulska & Rucinski, The designationof black peoplein psychiatric 1986;Muiroy & Shah, 1992).However,up to 50% of research
SHAH
these patients do not have psychiatric disorder
(MacMillan & Shaw,1966;Clark eta!, 1975).In such situations, Section47 of the National AssistanceAct 1948could beused.Here the patient can beremoved to a place of safety (usually a hospital bed) “¿if he is suffering from grave chronic diseaseor, being aged, infirm or physically incapacitated, is living in insanitary conditions and is unable to devote to himself and is not receiving from other persons
proper care and attention―.This act offers powers
SIR: Anthropologically
speaking,
there are only three
major ethnic divisions of Homo sapiens,namely the negroid, caucasoidand mongoloid races.Although the words ‘¿negroid' and ‘¿negro' are still used in
anthropology, there has been a tendency to avoid their useelsewhere,as theseterms have,principally thanks to American racism and the resultant civil rights movements,acquired a connotation of racial abuse. (Similar considerations apply to the term
